In Reply: Drs Lesser and Libow highlight the
challenges of prescribing for persons of advanced age in the context of limited
efficacy and safety data.

Older people certainly are poorly represented in trials. Our work illustrates
the magnitude of this problem. Among the 9664 subjects identified in our systematic
review of trials of nonsteroidal anti-inflammatory therapy for arthritis treatment,1 only 14 people were aged 75 to 84 years and none
were 85 years or older. Poor representation is likely compounded for women,
who are disproportionately represented in the oldest age group. Our systematic
review of myocardial infarction trials demonstrated that less than 25% of
participants were women and virtually none were of advanced age.2
These findings are inconsistent with the US Food and Drug Administration guidelines3 that encourage investigators to evaluate drug
therapies in the types of patients that will use them in clinical practice.